This article is part of a larger series titled “The End Of Roe.” Head here to read more.
When a draft decision that would fully overturn Roe v. Wade and end abortion access for millions of women leaked in early May, Justice Samuel Alito, who authored the decision, had a curious and inflammatory aside. He suggested that Black people who get abortions are committing genocide against their own race. In the draft, Alito wrote that some abortion advocates are “motivated by a desire to suppress the size of the African American population” and that this theory is correct because the majority of people who have had an abortion are Black.
But he did not mention pregnancy-related deaths among those very same people.
The real danger for Black mothers will come if Alito’s draft becomes the court’s final decision. Black women in the U.S. already face a dismal maternal death rate, and studies have shown that restricting abortion access will lead to a surge in pregnancy deaths.
More than half the states have trigger laws in place, meaning if Roe falls, abortion becomes illegal in that state. Reproductive health experts and advocates have been warning that this outcome will lead to an increase in deadly illegal abortions, the criminalization of pregnancy and a rise in the already high Black maternal death rate.
The United States’ maternal death rate is uniquely horrifying. Data shows that after years of declining, the rate began ticking back up starting in the year 2000, and researchers at the Centers for Disease Control and Prevention found that two out of three deaths were preventable.
The maternal death rate and the end of Roe are inextricably linked. If someone is denied an abortion, they are more likely to stay pregnant. The people who will have the hardest time accessing an abortion in a post-Roe world are Black, and they are more likely to die during pregnancy.
According to the CDC, in 2020 the maternal mortality rate was 23.8 deaths per 100,000 live births. But for Black people, the mortality rate was 55.3 deaths per 100,000 live births, which is 2.9 times the rate for their white counterparts.
Contrary to mainstream anti-abortion talking points, abortion deaths are exceedingly rare. In 2018, the latest data available from the CDC, two people died from complications from a legal abortion. The data shows that remaining pregnant is the more dangerous option.
“Forcing people to remain pregnant can kill them.”
Even though anti-choice activists and conservative leaders say their crusade to end legal abortion stems from so-called pro-life beliefs, there doesn’t seem to be any concern for the lives of pregnant people.
“Pregnancy can be less safe for some,” Jamila Taylor, the director of health care reform and senior fellow at The Century Foundation, told HuffPost. “And a lot of that is rooted in health equity and racism.” The worsening Black maternal death rate isn’t something that is set in stone, but rather a result of policy choices.
There are several different reasons why the Black maternal death rate is higher than other racial groups, but most trace back to structural racism. Black people are less likely to be listened to by their doctors. Higher rates of poverty mean that they are more likely to suffer from illnesses and diseases that can cause pregnancy complications. Lack of access to health care means that some complications are missed entirely.
Overturning Roe will have repercussions across the country, the brunt of it will fall on the backs of Black birthing people and women — many who already live in states with little access to abortion care and higher maternal mortality rates.
“States that have the poorest maternal health outcomes also have the most draconian abortion restrictions,” Taylor said. “These issues are obviously intertwined.”
In a study, Amanda Stevenson, a professor at the University of Colorado Boulder, found that if there were a nationwide abortion ban — an idea on the to-do list of GOP politicians — there would be a 21% increase in pregnancy-related deaths overall. For Black people, that increase would be 33%.
“It’s just a whole lot deadlier to stay pregnant and that increase in deadliness is profoundly and unjustly distributed,” she said. “Forcing people to remain pregnant can kill them.”
The fall of Roe would mean that in states where abortion is illegal, health care providers who are trying to save pregnant patients’ lives could also have to deal with strict policies that are made by lawmakers rather than based on science.
“I care for patients every week who are making difficult decisions about whether to terminate or carry their pregnancy to term because of a risk to their own health,” Dr. Jonas Swartz, an assistant professor of obstetrics and gynecology at Duke University, told HuffPost.
While states with the most severe restrictions like Texas and Oklahoma have exceptions for maternal health reasons, it’s not as simple as doctors deciding that an abortion is a necessary medical procedure. Swartz said he’d have to worry if his reasoning meets the legal requirements for an abortion.
The doctor treats many patients who deal with health issues that could be a threat to their lives.
“I’ve cared for a number of patients who have early onset preeclampsia,” Swartz said, referring to a potentially fatal pregnancy complication. “I’ve cared for patients who need an abortion because they’re in renal failure and patients that face a 30-50% mortality risk if they get pregnant.”
Abortion restrictions can take away the option to terminate, even if patients face dangerous health outcomes. “Those decisions are already hard to make,” Swartz said. “And these barriers are making them more difficult.”
A certain faction of religious extremists, conservative activists and Republican politicians has spent decades working to overturn Roe. They have chipped away at reproductive rights by passing laws and restrictions that are already forcing people to have unsafe abortions and criminalizing pregnancy. The fact that the most marginalized people are already suffering under this regime and will only suffer more once the final nail is in the coffin is not something that should surprise anyone.
For supporters of reproductive rights, the hypocrisy is infuriating: How can anti-abortion activists call themselves pro-life when they know that the thing they’re trying to accomplish will lead to more deaths?
But when have the deaths of Black people been a concern for followers of Christian conservatism? Black people are more likely to die of COVID, from police violence and due to poverty. For far too many, that’s just business as usual.
There is no definitive number on how many more Black people will die from pregnancy-related causes when Roe falls.
“The projections that we have are best guesses and there are a lot of assumptions,” Stevenson said. But that’s not really the important question, she said. “Don’t ask how many will die, but why will more people die?”